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Background  Volumes of paracardial adipose tissue ( PAT ) and epicardial adipose tissue ( EAT ) are greater after menopause. Interestingly,  PAT  but not  EAT  is associated with estradiol decline, suggesting a potential role of menopause in  PAT  accumulation. We assessed whether volumes of heart fat depot ( EAT  and  PAT ) were associated with coronary artery calcification ( CAC ) in women at midlife and whether these associations were modified by menopausal status and estradiol levels.    Methods and Results   EAT  and  PAT  volumes and  CAC  were measured using electron beam computed tomography scans.  CAC  was evaluated as (1) the presence of  CAC  ( CAC  Agatston score ≥10) and (2) the extent of any  CAC  (log  CAC  Agatston score >0). The study included 478 women aged 50.9 years (58% pre‐ or early perimenopausal, 10% late perimenopausal, and 32% postmenopausal).  EAT  was significantly associated with  CAC  measures, and these associations were not modified by menopausal status or estradiol. In contrast, associations between  PAT  and  CAC  measures were modified by menopausal status (interaction‐ P ≤0.01). Independent of study covariates including other adiposity measures, each 1‐SD unit increase in log  PAT  was associated with 102% higher risk of  CAC  presence ( P =0.04) and an 80% increase in  CAC  extent ( P =0.008) in postmenopausal women compared with pre‐ or early perimenopausal women. Additional adjustment for estradiol and hormone therapy attenuated these differences. Moreover, the association between  PAT  and  CAC  extent was stronger in women with lower estradiol levels (interaction  P =0.004).    Conclusions  The findings suggest that  PAT  is a potential menopause‐specific coronary artery disease risk marker, supporting the need to monitor and target this fat depot for intervention in women at midlife.

journal of the american heart association

Postmenopausal Women With Greater Paracardial Fat Have More Coronary Artery Calcification Than Premenopausal Women: The Study of Women's Health Across the Nation (SWAN) Cardiovascular Fat Ancillary Study